Meningioma
If you've been told you have a meningioma, you're dealing with the most common primary brain tumor in adults — and in most cases, the most treatable. Here is what you need to know about whether to watch it, whether to operate, and why the molecular details of your specific tumor now matter as much as its size.
What Is Meningioma?
Meningiomas arise from the meninges — the membranes covering the brain and spinal cord. They account for about 38% of all primary brain tumors and are the most common primary intracranial tumor. Most are benign (WHO grade 1 in ~80%), slow-growing, and incidentally discovered. The challenge lies in choosing between watchful waiting, surgery, and radiation — and the right choice depends heavily on the tumor's location, size, symptoms, and molecular features.
The 2021 WHO classification introduced molecular markers that can upgrade a histologically 'benign' meningioma. CDKN2A/B homozygous deletion now defines WHO grade 3 regardless of histology.
At a Glance
- Meningiomas are the most common primary brain tumor — benign WHO grade 1 in ~80% of cases
- Many are found incidentally; small, asymptomatic meningiomas can be safely observed with serial MRI
- Surgery is preferred for large, symptomatic, or growing tumors — Simpson grade 1 resection is the target
- WHO 2021 molecular classification can upgrade grade based on CDKN2A/B deletion, TERT mutation, or other markers
- Stereotactic radiosurgery is highly effective for tumors ≤3 cm, especially in recurrent, residual, or eloquent locations
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